Ann Clin Microbiol.  2016 Jun;19(2):39-47. 10.5145/ACM.2016.19.2.39.

Molecular Epidemiology and Characterization of Carbapenemase-Producing Enterobacteriaceae Isolated at a University Hospital in Korea during 4-Year Period

• Ahn S
• Sung JY
• Kim H
• Kim MS
• Hwang Y
• Jong S
• Seo Y
• Ha E
• Park ES
• Choi JY
• Yong D
• Lee K

• KMID: 2307782
• DOI: http://doi.org/10.5145/ACM.2016.19.2.39

Abstract

BACKGROUND
Carbapenemase-producing Enterobacteriaceae (CPE) has been increasingly reported worldwide in the past 10 years, which is an important infection control concern. Since the epidemiology and characteristics of these CPEs vary according to institutes, we aimed to characterize CPEs in a university hospital during the recent 4 years.
METHODS
From October 2011 to September 2015, CPE isolates from clinical specimens and hospital surveillance cultures were collected. Carbapenem resistance was confirmed by disk diffusion method and Minimal Inhibitory Concentration (MIC) was determined by agar dilution method. Carbapenemase production was tested by double disk test using aminophenylboronic acid and dipicolic acid. PCR and sequence analysis were performed to detect bla(KPC), bla(IMP-1), bla(VIM-2), bla(NDM-1)-like genes and bla(OXA-48) gene. Pulsed-field gel electrophoresis (PFGE) and Multilocus sequence typing (MLST) were conducted for KPC-producing Klebsiella pneumoniae isolates.
RESULTS
Twenty-five isolates (11%) of CPE were identified among 222 carbapenem-resistant Enterobacteriacae isolates during the study period. The most prevalent CPE was KPC-producing K. pneumonia and others were IMP-1, VIM-2, NDM-1 type and OXA-48 producing CPEs. Most of these CPEs showed resistance to carbapenems with variable MICs. The sequence types (STs) of KPC-producing K. pneumoniae were ST307 and ST11. The PFGE of ST11 and ST307 showed clonality in each group suggesting the possibility of in-hospital outbreak.
CONCLUSION
The prevalence of CPE has been increasing. In our institute, KPC-producing K. pneumoniae was the most frequently isolated CPE in the recent 4 years. CPE including KPC producers can easily transfer their resistance. Therefore continuous monitoring and more intensified infection control for CPE should be considered.

Keyword

Beta-lactamase KPC; Carbapenem resistance; Enterobacteriaceae; Klebsiella pneumoniae

MeSH Terms

Academies and Institutes
Agar
Carbapenems
Diffusion
Drug Resistance, Bacterial
Electrophoresis, Gel, Pulsed-Field
Enterobacteriaceae*
Epidemiology
Infection Control
Klebsiella pneumoniae
Korea*
Methods
Molecular Epidemiology*
Multilocus Sequence Typing
Pneumonia
Polymerase Chain Reaction
Prevalence
Sequence Analysis
Agar
Carbapenems

Figure

• 

  Fig. 1. The number of carbapenemase-producing Enterobacteriaceae isolates and carbapenemase types reported annually.

• 

  Fig. 2. KPC-producing Klebsiella pneumoniae dendrogram based on Pulsed-field gel electrophoresis (PFGE) pattern and their sequence type. Abbreviation: ST, sequence type.

Reference

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